Lucy: “do you think anybody ever really changes” Linus: “Ive changed a lot in the last year” Lucy: “I mean for the better” – Peanuts
Driving the financial results of most hospitals, the operating room commonly generates over 50% of revenues and profits. As such, alterations in OR performance will have an extraordinary effect on a facilitys bottom line. Therefore, high on the list of objectives for most facilities is to increase case volume, improve surgeon satisfaction, reduce costs, or bolster market share and contribution margins. In order to meet these vital objectives the principles of six sigma process improvement may be adapted to the OR, yielding a targeted and structured plan of action.
As co-founder of multiple anesthesia groups as well as a large anesthesia practice management company, I have been fortunate to have a unique “behind the scenes” perspective of numerous operating rooms nationwide. The variability of processes both within a given facility, and certainly between facilities, is striking. This variation often leads to an unpredictable peri-operative experience and dissatisfaction on the part of the primary operating room customer the referring surgical staff.
How can this be related to six sigma? Six sigma is an ongoing improvement initiative designed to enhance profitability and meet customer needs by reducing both product defects and process variability. The concept of measuring defects was constructed as a universal quality metric that would apply to products or services of varying complexity and across industries. It is often easier to conceptualize sigma levels by translating them into the quality yield, or the percentage of error free processes achieved at a particular sigma level of performance (see Table 1). Utilization of the rigorous six sigma approach to improve many complex interrelated business processes has yielded dramatic financial returns in both manufacturing and service industries.
Sigma level
Defects per million opportunities (DPMO)
Quality Yield
2
308,537
69%
3
66,807
93.3%
4
6210
99.4%
5
233
99.98%
6
3.4
99.999%
Table 1
While most common business processes perform at a 3 to 4 sigma baseline level, many healthcare processes lag behind at 1 to 3 sigma. Recognizing the large potential for improvement from low baseline sigma levels; and that the peri-operative experience is a complex series of interrelated processes, Healthcare Performance Strategies (HPS) has adapted six sigma principles to the operating room environment. Commencing with the charter and instruction of a multi disciplinary OR improvement team, the OR optimization program focuses on surgeon requirements to define process performance. In order to optimally apply six sigma principles, the entire peri-operative experience must be broken down into manageable (and measurable) “bite sized pieces”.
Utilizing the proprietary HPS “OR continuum”, the peri-operative period is broken into 9 specific and easy to define components. This allows for analysis and improvement of each component independently. Once the current performance of each component is delineated and benchmarked, ties to overall OR throughput will identify root cause “process bottlenecks”. This allows for priority assignment to various process components.
Implementing a framework valuing facility goals and surgeon requirements, a point system will quantify and rank the bite-sized processes for improvement. Once prioritized, processes will be subjected to rigorous analysis based upon the six sigma DMAIC model. Standing for Define, Measure, Analyze, Improve and Control, this improvement model has been tested and refined extensively in a wide variety of industries. Each chosen process undergoes an independent analysis, with the goal of reducing both complexity and variability. Ongoing data analysis yields quantitative information on realized process gains and assures continued process stability. As is clear in Table 1, as processes are improved from the low 1 to 3 sigma levels often seen in healthcare, a dramatic rise in error free completion will result, yielding better performance metrics, surgeon satisfaction and ultimately profitability.
So in order to achieve your big picture goals in the operating room, it may be wise to dig a bit deeper into the peri-operative experience, breaking it down into bite sized pieces. By doing so and then applying sophisticated six sigma improvement techniques, you will be able to take giant strides to meeting the needs of your surgeons and your operating room objectives.
Lucy: “do you think anybody ever really changes”
